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Paramesh Ndc. Adrian Chivu. Diana Druta. Casandra Costin. Anonymous Bt6favSF4Y. Huda Nasir. Kamrul Hasan Rahat. Dr Qaisar. Syrian Freedom Bird. Marina Cretu.
Gujapaneni Ravi Kumar. Ashri Ratnasari. Phil Beckett. Andrei Celac. Grossmans Endodontic Practice 12th Edition Preview. Shanmukha Yarlagadda. Ina Permata Dewi. Nazrul Islam. Kim Patrick Victoria. Biomedical concept: This concept has its basis in the germ theory of diseases which dominated medical thought at the turn of the 20th century.
The medical profession viewed the human body as a machine, disease as a consequence of breakdown of the machine and one of the doctors task as repair of the machine. Thus health in this narrow view was termed as absence of disease.
This concept minimized the role of environment, social, physiological and cultural determinants of health. Developments in medical and social sciences led to the conclusion that biomedical concept of health was inadequate. Ecological concept: The ecologists put forward an attractive hypothesis which viewed health as a dynamic equilibrium between man and his environment and disease as maladjustment of the human organism to environment.
Psychosocial concept: Contemporary development in social sciences revealed that health is not only a biomedical phenomenon but one which is influenced by social, psychological, cultural, economic and political factors of the people concerned.
These factors must be taken into consideration in defining and measuring health. Thus health is both a biological and social phenomenon. Holistic concept: It is a synthesis of all the above mentioned concepts. It recognizes the strength of social, economic, political and environmental influences on health.
This implies a sound mind in a sound body in a sound family in a sound environment. It implies that all sectors of society have a effect on health. The various dimensions function individually in its own nature and interact with one another and thus constitutes to health. Dysfunction or disturbance in the equilibrium of the various factors will alter the health.
The different dimensions of health are: Physical Dimension It is probably the easiest to understand. It conceptualizes health biologically as a state in which every cell and every organ is functioning at optimum capacity and in perfect harmony with the rest of the body. Mental Dimension The mental health has been defined as a state of balance between the individual and the surrounding world, a state of harmony between oneself and others, a co-existence between the realities of the self and that of the other people and that of the environment.
The mind and body were considered independent entities but however researchers have discovered that psychological factors can induce all kind of illness, not simple mental ones.
Social Dimension Social well being implies harmony and integration within the individual, between each individual and other members of society and between individuals and the world in which they live. It includes the levels of social skills one possesses, social functioning and the ability to see oneself as a member of the larger society. Spiritual Dimension Spiritual health in this context refers to that part of the individual which reaches out and strives for meaning and purpose in life.
Proponents of holistic health believe that time has come to give serious consideration to the spiritual dimension and to the role this plays in health and disease. Emotional Dimension Historically the mental and emotional dimensions have been seen as one element or as two closely related elements.
However as more research becomes available, a definite difference is emerging. Vocational Dimension It is a new dimension. It is part of human existence and plays a role in promoting both physical and mental health. Others A few other dimensions have also been suggested such as: philosophical dimension, cultural dimension, socio-economical dimension, environmental dimension, educational dimension, nutritional dimension, curative dimension, and preventive dimension.
The lowest point on the spectrum is death and the highest point is the positive health Fig. The spectral concept of health emphasizes that the health of an individual is not static, it is a dynamic phenomenon and a process of continuous change within a range of optimum well being to various levels of dysfunction, including the state of total dysfunction namely the death.
What is considered maximum health today may be considered minimum tomorrow. It implies that health is a state not to be attained once and for all but ever to be renewed. Mortality indicators.
Morbidity indicators. Disability rates. Nutritional status indicators. Health care delivery indicators. Utilization rates.
Indicators of social and mental health. Environmental indicators. Socio-economic indicators. Health policy indicators. Indicators of quality of life. Other indicators e.
The factors which influence health lie both within the individual and externally in the society in which he or she lives. These factors interact and these interactions maybe health promoting or deleterious.
The most important determinants of health are heredity, environment, lifestyle, socio-economic conditions, health and family services and other factors. The genetic makeup is unique and it can not be altered after conception. A number of diseases are known to be of genetic origin, e. The state of health therefore depends partly on the genetic constitution of man.
Environment: Environment is classified as internal and external.
Internal environment of man pertains to each and every component, part, tissue, organ and their harmonious functioning within the system. These can be divided into physical, biological and psycho-social components all of which can affect the health of man and his susceptibility to illness.
The environmental factors play a very important role in determining health of the individual. Lifestyle: Lifestyle means the way people live and this reflects the social values, attitudes, activities, culture, behavioral patterns and personal habits. Health requires the promotion of healthy lifestyles. Many current day health problems like obesity, lung cancer, drug addiction, heart disease, diabetes are associated with lifestyle changes.
Socioeconomic conditions: For years health has been a privilege and not a right. Socioeconomic conditions have long been known to influence health. The per capita GNP is the most widely accepted measure of general economic performance. The economic status determines the downloading power, standard of living, quality of life, family size, health care and the pattern of disease in the community. Ironically affluence may also be a contributing cause of illness, e. Education: The second major factor influencing health status is education.
The world map of illiteracy closely coincides with the maps of poverty, malnutrition, ill health and high child mortality rates. Studies indicate that education to some extent compensates the effects of poverty on health. Kerala in India is a striking example of highest literacy rate and lowest infant mortality rate. Occupation: The very state of being employed in productive work promotes health. For many, loss of work may mean loss of income and status. It can cause psychological and social damage.
The resources allocation, manpower policy, choice of technology and the degree to which health services are made available to different sects of people are governed by the political system. If the health pattern of the community has to be changed, the political as well as social and economical actions are required. The purpose of health services is to improve the health status of the population. All these are ingredients of what is now termed as primary health care.
Other factors: Other contribution to health of population, derived from systems outside the formal healthcare system, e.
These systems would assist in raising the standard of living, would increase the employment opportunities, provide medical programs and support family programs.
In short medicine is not the sole contributor to the well being of the population, the potential of intersectoral contribution is the demand of the hour.
Germ theory of disease: This concept gained momentum during the 19th and the early part of 20th century. The emphasis had shifted from empirical causes e.
The disease model was referred to as one to one relationship between causal agent and disease. Epidemiological triad: This encompasses a broader concept of disease causation.
It includes factors like the agent, the host and the environment. This model has helped epidemiologists to focus on different classes of factors, especially with regards to infectious disease. Multifactorial causation: Pettenkofer of Munich was an early proponent of the concept that disease is due to multiple factors. The modern days, diseases like lung cancer, bronchitis, chronic heart diseases, mental illness etc. This theory de-emphasizes the concept of disease agent and stresses multiplicity of interactions between host and environment.
Web of causation: This model of disease causation was suggested by Macmohan and Pugh. This model is ideally suited in the study of chronic diseases where the disease agent is often not known but is the outcome of interaction of multiple factors. It considers all the predisposing factors of any type and their complex inter relationship with each other.
Seesaw concept Fig. In this the agent of the disease A and the host H are at the opposite end of the seesaw and the fulcrum is the environment E. It signifies the way in which disease evolves over the time from the earlier stage of its prepathogenesis phase to its termination as recovery and disability or death. This can be studied under two phases. Prepathogenesis phase: This refers to the period before the onset of disease in man.
The disease agent has not yet entered man but the factors which favor its interaction with the human host are already existing in the environment. Pathogenesis phase: This phase begins with the entry of the disease agent in the susceptible human host. The further events in the pathogenesis phase include disease agent multiplication, physiological changes, progression of disease through a period of incubation and later through early and late pathogenesis.
The final outcome of the disease may be recovery and disability or death. The pathogenesis phase could be modified by intervention measures such as immunization and chemotherapy.
The floating tip of the iceberg represents what the physician sees in the community, i. The vast submerged portion of the iceberg represents the hidden mass of the disease, i. The waterline represents the demarcation between the apparent and the inapparent disease. The hidden part of the iceberg thus constitutes an important, undiagnosed reservoir of infection or disease in the community and its detection and control is a challenge to modern techniques of prevention.
One of the major deterrents in the study of chronic diseases of unknown etiology is the absence of methods to detect the sub-clinical state bottom of the iceberg. ANSWER 11 Incubation Period It is defined as the time interval between invasion by an infectious agent and appearance of the first sign and symptom of the disease in question. The incubation period varies for different infectious diseases and also from one person to another with the same disease.
In some, incubation period is very short. The length of incubation period is characteristic of each disease. Medium incubation time days to 3 weeks e. Long incubation time: Months to years Hepatitis A,B, rabies, etc. Incubation time is of fundamental importance in epidemiological studies: Tracing the source of infection and contacts. To determine the period of surveillance. For immunization. To identify the point source or propagated epidemics. To estimate the prognosis of a disease.
These factors should interact over a period of time for the disease to occur. Disease agents may be classified broadly into the following groups: 1 Biological agents: These are living agents of disease—viruses, rickettsiae, fungi, bacteria, protozoa and metazoa. The occurrence of the disease is based on the infectivity, pathogenicity and virulence of the organism. Nutrient agents: Any excess or deficiency in the intake of proteins, fats, carbohydrate, vitamins, minerals and water may result in nutritional disorders.
Physical agents: Exposure to excess heat, cold, humidity, pressure, radiation, electricity sound, etc. Chemical agents: Endogenous- some of the chemicals may be produced in the body as a result of derangement of function, e.
Exogenous- agents arising outside of human host, allergens, metals, fumes, dust, gases, etc. These may be acquired by inhalation, ingestion or inoculation. Mechanical agents: Exposure to chronic friction and other mechanical forces may result in crushing, tearing, sprains, dislocation and even death.
Social agents: Poverty, abuse of drugs, unhealthy lifestyles, social isolation, etc. Host In epidemiological terminology, the human host is referred to as soil and the disease agent as the seed.
The host factors may be classified as: 1. Demographic characteristics—e. Social and economic factors. The association of a particular disease with a specific set of host factors frequently provide an insight into the cause of the disease.
Physical environment: It is applied to non-living things and physical factors air, water, soil, housing, etc. Biological environment: It is the universe of the living things which surrounds man, including man himself. The living things are the viruses and other microbial agents, insects, rodents, animals and plants.
These are constantly working for the survival and in this process, some of them Act as disease-producing agents, reservoirs of infection, intermediate hosts and vectors of disease. They include cultural values, customs, beliefs, attitudes, morals, religion, education, lifestyle, community life, healthcare services, social and political organization. They are often suggestive, but not a absolute proof of cause and effect relation. The risk factors may be truly causative e. Some risk factors may be modified and thus can help in the process of prevention, while some cannot be modified e.
Epidemiological methods are needed to identify risk factors and estimate the degree of risk. Examples of Risk Factors 1. Dental caries—Risk factors: Sugar, malocclusion, poor oral hygiene, xerostomia, etc.
Periodontal disease—Risk factors: Plaque, calculus, overhanging restorations, etc. Oral cancer—Risk factors: Tobacco, alcohol, virus, iron deficiency, etc. Heart disease—Risk factors: Obesity, smoking, blood-pressure, elevated serum cholesterol.
The detection of the risk factors should be considered a prelude to prevention or intervention. This kind of approach helps in saving the resources and also attending those people who need urgent care. Biological situation Age groups: Infants, toddlers, geriatric population. Sex: Females in the reproductive age. Physiological state: Pregnancy, cholesterol levels, high blood pressure. Genetic factors: Family history of genetic disorder.
Other health conditions: Disease, physical malfunctioning, unhealthy behavior. Physical situation Unhealthy living conditions, locality rural, urban slums , overcrowding. Environmental conditions: Poor water supply, proximity to industries. Socio-cultural and cultural situation Social class: Lower socio-economic class Customs: Harmful to health.
Lifestyles: Consuming high cholesterol diet, increased sugar consumption, etc. Habits: Those smoking, chewing tobacco, alcohol users, etc.
Lack of education and lack of access to healthcare. They are probably the most often used indirect indicators of health. According to Dorland, it is the condition of being diseased or morbid. It is similar to the spectrum of light where the colors vary from one end to the other, but difficult to determine where one color ends and the other begins.
At one end of the disease spectrum are subclinical infections which are not ordinarily identified and at the other end are the fatal illnesses. In the middle of the spectrum lie illnesses ranging in severity from mild to severe. Define epidemiology. Aims of epidemiology and uses of epidemiology. What are the different types of epidemiological studies? Describe the procedural steps in descriptive epidemiology.
Compare and contrast the retrospective and prospective studies. Experimental epidemiology. How do you design an epidemiological investigation? Write a note on scientific method in epidemiology. Tools of measurements. Cross-sectional study. Longitudinal study. Case control study. Cohort study. Refer Ans 12 Attributable risk.
Refer Ans 13 Relative risk. Analytical studies. Non-randomized control trials. Principles of epidemiology. Confounding factor. Descriptive epidemiology. Analytical epidemiology.
Defining the population to be studied. Defining the disease under study. Describing the disease. Measurement of disease. Comparing with known indices. Formulation of etiological hypothesis. Defining the Population to be Studied The first step is therefore to define the population base.
Defined population can be the whole population in a geographic area, or specifically selected group such as age, sex, occupational, cultural characters and school children. The community chosen should be stable, without migration. Community participation is essential. Defining the Disease Under Study The disease is defined in such a way that it helps in identifying and measuring the disease in the defined population with a degree of accuracy.
Describing the Disease The occurrence and distribution of disease is described by time, place and person. Time Distribution The epidemiologists have identified three kinds of time trends or fluctuations in disease occurrence.
Short-term fluctuations. Periodic fluctuations. Long-term fluctuations. Short-term fluctuations: The epidemic is the best known example for short term fluctuation. The three major types of epidemics may be distinguished as: a. Common source epidemics b.
Propagated epidemics c. Slow epidemic a. Common source epidemics or point source epidemics: i. Single exposure: These are known as point source epidemics. The exposure of diseased agent is brief and essentially simultaneous; the resultant cases all develop within one incubation period, e.
Continuous or multiple exposures: Some times the exposure from same source may be prolonged, continuous repeated or intermittentnot necessarily at the same time or place, e. Slow epidemic: This is well known for non-communicable diseases which are lifestyle related, e.
These conditions take a long time to manifest and are slowly progressive in nature. Periodic fluctuations a. Seasonal trend: It is well known for many communicable diseases.
The seasonal variations of disease occurrences may be related to environmental condition, e. Cyclic trend: Some diseases occur in cycles spread over short periods of time which may be days, weeks, months, years, e.
Long term or secular trends: The term secular trend implies changes in the occurrence of disease progressive increase or decrease over a long period or time, generally several years or decades, e. Place Distribution It is the study of geographical distribution of cases in different population. By studying this variation, the disease pattern has been found.
The distribution of diseases according to places can be classified as: 1. International variation 2. National variation 3. Local variation. International variation: Descriptive studies by place have shown that the pattern of disease is not the same everywhere. For example we know cancer exists all over the world, but the incidence of different types of cancer varies with respect to the places.
Cancer of the stomach is very common in Japan but unusual in US. Cancers of the oral cavity and uterine cervix are exceedingly common in India as compared to industrialized countries. National variation: Variation in the prevalence and incidence of the disease occurrence exists within countries or national boundaries.
For the example the distribution of endemic goiter, lathyrism, flourosis, guinea —worm disease, leprosy, malaria, nutritional deficiency diseases have all shown variations in their distribution in India, with some parts of the country more affected and others less affected or not affected at all.
Chronic bronchitis, accidents, lung cancer, cardio-vascular diseases, mental illness and drug dependence are usually more frequent in urban than in rural areas. On the other hand skin, zoonotic diseases and soil-transmitted helminths may be more frequent in rural areas than in urban areas.
Local distribution: Inner and outer city variations in disease frequency are well known. These maps show at a glance areas of high or low frequency, the boundaries and patterns of disease distribution. It was a spot map of fatal cases by John Snow of England in his classic investigation of cholera epidemic in in the golden square district of London, which could focus attention on the common water pump in board street as the source of infection.
Person Distribution In descriptive studies, the disease is further characterized by defining the persons who develop the disease by age, sex, occupation, marital status, habits, social class and other host factors. These factors do not necessarily represent etiological factors, but they contribute a good deal to our understanding of the natural history of disease.
Age: Age is strongly related to disease than any other single host factor. Certain diseases are more frequent in certain age groups than in others, e. Sex: It is another host characteristic which is often studied in relation to disease.
It has been found that certain chronic diseases such as diabetes, hyperthyroidism and obesity are strikingly more common in women than men and diseases such as lung cancer and coronary heart diseases are less frequent in women.
Ethnicity: Differences in disease occurrence have been noted between population subgroups of different racial and ethnic origin. Differences whether they are related to genetic or environmental factors have been a stimulus to further studies.
Marital status: In countries where studies on mortality in relation to marital status have been conducted, it was found that mortality rates were always lower for married males and females than for the unmarried, of the same age and sex. Occupation: It may alter the habit pattern of employees, e.
It is obvious that persons working in particular occupations are exposed to particular types of risks. Workers in coal mines are more likely to suffer from silicosis. Social class: Individual in the upper social classes has a longer life expectancy and better health and nutritional status than those in the lower social classes.
Certain diseases e. Behavior: Human behavior is increasingly looked upon as a risk factor in modern-day diseases such as coronary heart diseases, cancer, obesity and accidents.